A Prospective, Population-Based Study of the Demographics, Epidemiology, Management, and Outcome of Out-of-Hospital Pediatric Cardiopulmonary Arrest

Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA.
Annals of Emergency Medicine (Impact Factor: 4.68). 03/1999; 33(2):174-84. DOI: 10.1016/S0196-0644(99)70391-4
Source: PubMed


STUDY OBJECTIVEs: To perform a population-based study addressing the demography, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest (PCPA).
Prospective, population-based study of all children (17 years of age or younger) in a large urban municipality who were treated by EMS personnel for apneic, pulseless conditions. Data were collected prospectively for 3(1/2) years using a comprehensive data collection tool and on-line computerized database. Each child received standard pediatric advanced cardiac life support.
During the 3(1/2)-year period, 300 children presented with PCPA (annual incidence of 19. 7/100,000 at risk). Of these, 60% (n=181) were male (P =.0003), and 54% (n=161) were patients 12 months of age or younger (152,500 at risk). Compared with the population at risk (32% black patients, 36% Hispanic patients, 26% white patients), a disproportionate number of arrests occurred in black children (51.6% versus 26.6% in Hispanics, and 17% in white children; P <.0001). Over 60% of all cases (n=181) occurred in the home with family members present, and yet those family members initiated basic CPR in only 31 (17%) of such cases. Only 33 (11%) of the total 300 PCPA cases had a return of spontaneous circulation, and 5 of the 6 discharged survivors had significant neurologic sequelae. Only 1 factor, endotracheal intubation, was correlated positively with return of spontaneous circulation (P =.032).
This population-based study underscores the need to investigate new therapeutic interventions for PCPA, as well as innovative strategies for improving the frequency of basic CPR for children.

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    • "However, the social and emotional impact of the death of a child is enormous. In the USA alone, an estimated 16 000 children die each year from sudden cardiac arrest (Sirbaugh et al., 1999). The most common cause of cardiac arrest in children is respiratory arrest, although the incidence of cardiac arrest caused by ventricular arrhythmias increases with age (Appleton et al., 1995; Atkins et al., 1998). "
    Tachycardia, 03/2012; , ISBN: 978-953-51-0413-1
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    • "SCD is 10 times less frequent in children than in adults. However, only in the US, an estimated 16 000 children die each year from sudden cardiac arrest (Sirbaugh et al., 1999). Moreover, the social and emotional impact of the death of a child is enormous because of the greater life expectancy. "
    Cardiac Defibrillation - Mechanisms, Challenges and Implications, 09/2011; , ISBN: 978-953-307-666-9
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    • "Other factors related to reduced survival are prolonged duration of CPR (O15 minutes) and need for more than three doses of epinephrine [26]. Trauma patients who develop CPA also have poor outcome [4], most likely because of direct brain and organ injury; hypovolemic or obstructive shock, which limits the likelihood that CPR will maintain adequate brain blood flow; and delay in achieving definitive surgical intervention. "
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    ABSTRACT: This article summarizes the current state of outcomes and outcome predictors following pediatric cardiopulmonary arrest with special emphasis on neurologic outcome. The authors briefly describe the factors associated with outcome and review clinical signs, electrophysiology, neuroimaging, and biomarkers used to predict outcome after cardiopulmonary arrest. Although clinical signs, imaging, and somatosensory evoked potentials are best associated with outcome, there are limited data to guide clinicians. Combinations of these predictors will most likely improve outcome prediction, but large-scale outcome studies are needed to better define these predictors.
    Pediatric Clinics of North America 09/2008; 55(4):969-87, xi. DOI:10.1016/j.pcl.2008.04.008 · 2.12 Impact Factor
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